A series from Science Based Health http://www.visioncareprofessional.com/emails/SBH/2/index.asp
Tip #1: Be knowledgeable and confident about the clinical research around dry eye and nutrition.
There are numerous studies specifically on dry eye and nutrition. Some omega fatty acids have been clinically shown to help manage inflammation and dry eye. Others have been linked to lower risk of dry eye in population-health studies. Some studies to support this include:
• In a review of treatments for dry eye, the authors indicate that GLA or Gamma-linolenic acid (an essential omega-6 fatty acid from evening primrose oil or black currant seed oil) has been shown to inhibit inflammation in patients diagnosed with keratoconjunctivitis sicca.1 Other clinical studies have reported improvement in objective and/or subjective symptoms with GLA in people with inflammatory dry eye, post-PRK dry eye, and Sjogren’s syndrome.
• The Women’s Health Study which assessed 39,876 women, found that those consuming the most omega-3 (EPA & DHA) from fish had a statistical decrease in the incidence of dry eye disease compared to those eating the least.2
• There is even a study specifically on contact lens related dry eye and oral omega-6 essential fatty acids (e.g. GLA) that showed a statistically significant benefit in alleviating dry eye symptoms and improving overall lens comfort in patients suffering from contact lens associated dry eye.3
• There are many more but knowing a few key studies will help with your recommendation to patients and in answering their questions ranging from contact lens related dry eye to severe forms of dry eye like KCS to the women’s health study benefits.
References:
1. Gumus K, Cavanagh DH. The role of inflammation and anti-inflammation therapies in keratoconjunctivitis sicca. Clin Ophthalmol. 2009;3:57-67. Epub 2009 Jun 2.
2. Miljanović B, Trivedi KA, Dana MR, Gilbard JP, Buring JE, Schaumberg DA. Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr. 2005 Oct;82(4):887-93.
3. Kokke KH, Morris JA, Lawrenson JG. Oral omega-6 essential fatty acid treatment in contact lens associated dry eye. Cont Lens Anterior Eye. 2008 Jun;31(3):141-6; quiz 170. Epub 2008 Mar 4.
Tip #2: Determine patient’s level of nutrition / eating habits during the initial history portion of the dry eye work-up.
• Ask patients if they feel they eat a healthy diet, such as 2-3 servings of fruit and vegetables per day and 3 or more servings of fish per week. These questions can give you an idea of the patient’s overall nutritional habits to see if they might benefit from a nutritional supplement.
• It is best if you as the doctor discuss nutrition and make a recommendation that the patient consider a dry eye nutrition product – such as HydroEye® (SBH) – that includes the important fatty acids (GLA, EPA and DHA) along with other vitamins. You can even discuss some of the research around dry eye and contact lens wear or KCS at that time.
• Another important tip is to make sure the patient is compliant with the full dose. SBH products are made from high quality, bioavailable ingredients and I have found that patients can immediately begin with the full daily dose rather than having to work up to it.
• Set proper expectations. Improvements in dry eye symptoms typically take 30-60 days with HydroEye. However, I tell patients that they may notice improvements in their skin and hair within 2-4 weeks.
Tip #3: Schedule follow-up exams to determine that what you prescribed, such as nutritional supplements, are benefiting the patient.
• My typical follow-up visit is 4-6 weeks after the initial dry eye work-up examination. This provides enough time that patients are seeing the effect. If I am also prescribing an ester-based corticosteroid with cyclosporine then I might see them at 3-4 weeks but if I am recommending a nutritional supplement like HydroEye and an artificial tear for a mild dry eye patient, I like to see the patient back in 4-6 weeks.
• Recommend nutritional supplements early on in the disease diagnosis. The Delphi panel recommendations from the International Task Force on Dry Eye suggested that nutritional supplements be included at level two dry eye. This is where patients have mild signs and some symptoms.
• One of the nice things about nutritional supplements is that they can be recommended concurrently with any topical treatment you prescribe to your dry eye patients.
• I have found that in patients with dry eye and poor nutritional habits, their dry eye seems to respond very well to nutritional supplements. Since most of us don’t eat healthy all of the time, most patients will benefit however the patients with consistently poor nutritional habits seem to notice the difference more quickly.
• When the patient returns do the same testing as your first dry eye work-up exam such as a symptom questionnaire, corneal or conjunctival staining, osmolarity measurements and Tear Break-up Time. As the research shows you will typically see significant improvement and this helps with patient compliance long-term. I would share the data findings of your follow-up tests with the patient and encourage their continued nutritional and good-health approaches.
